[Study of the platysma coli muscle vascularisation by the facial artery. Implication during the elevation of the musculo-cutaneous platysma coli muscle flap]. / Etude de la vascularisation du muscle platysma coli par les branches de l'artère faciale. Implications lors du prélèvement du lambeau musculo-cutané de platysma coli.

AIM OF THE STUDY: The purpose of this study was to assess the vascularity of the platysma muscle by the branches of the facial artery, in order to determine the best means of harvesting a musculo-cutaneous flap while ensuring maximum vascular security. PATIENTS AND METHODS: Ten platysma muscles were dissected on 4 fresh specimens and one formaldehyde-preserved specimen. The dissection was performed after injection of the facial artery in 6 cases, while 4 muscles were dissected without any previous injection. RESULTS: The vascular supply of the platysma muscle comes essentially from the branches of the submental artery and from branches descending straight from the facial artery. Other collateral branches contribute to this vascularization, but their importance is minor. All these arteries reach the muscle, entering its visceral aspect, then proceed to the sternal notch in a radial axis. CONCLUSION: The size of the flap has to be defined within a quadrilateral figure with its base formed by the mandibular edge and its apex by the inferior limit of the flap. It is essential to preserve the maximum possible muscular thickness, especially on the medial side of the flap. If the facial artery needs to be ligated, this has to be done as it enters the submandibular space in order to protect most of the collateral branches destined to the muscle. The vascularization is then taken back by the homo- and contro-lateral facial vascularisation in an inverted flow in the remaining segment of the facial artery.

Laser-assisted surgery addressing snoring long-term outcome comparing CO2 laser vs. CO2 laser combined with diode laser.

Our study encompasses 61 patients (49 men--80.3%; 12 women--19.7%) treated from September 1998 through August 2001. Mean follow-up covers 25 months (range: 7-43 months). Our CO2-LAUP technique involves vaporizing the palatine mucosa along a rectangular surface from the palatal dimple to the base of the uvula; trimming the palatine arches under the velum; and resecting the uvula. For 22 patients, we employed intravelar diode laser coagulation in the expectation of reducing the postoperative pain whilst achieving the same therapeutic effectiveness. There is no pain difference between the CO2-LAUP technique versus that combining intravelar diode laser coagulation with CO2 laser uvula resection and trimming of the palatine arches. Mean maximal pain reaches 6.93 +/- 3.55 with CO2 laser and 6.95 +/- 3.64 with CO2 laser plus diode laser. Similarly, both techniques involve the same mean algesic period of 22 days with the day of maximal pain at 1 week after surgery. Associating base of tongue vaporization significantly increases the algesic period (p = 0.042). No long-term complications were observed in relation to intravelar coagulation or LAUP, whether combined or not with base of tongue vaporization. In terms of patients satisfaction, no significant difference exists between the various surgical techniques of the velum alone. The satisfaction rate reaches 5.26 +/- 3.92 with CO2 laser and 5.82 +/- 2.67 with the CO2 laser plus diode laser. Satisfaction is statistically identical when base of tongue vaporization is included in the procedure.